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� CITY OF ORONO PERMIT NO.: 20o9-oos64 <br /> 2750 KELLEY PARKWAY <br /> � ORONO, MN 55356- DATE IssuEn: 09/09/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 175 CRYSTAL CREEK RD <br /> PIN : 33-118-23-33-0006 <br /> LEGAL DESC : CRYSTAL CREEK <br /> : LOT 005 BLOCK 001 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ROOFING-ASPHALT <br /> ACTNITY : O/S BUILDING-UNDEFINED <br /> VALUATION : $ 12,236.00 <br /> APPLICANT PERM[T FEE SCHEDULE 236.00 <br /> COMMUNITY CONSTRUCTION STATE SURCHARGE(VALUATION) 6.12 <br /> 11827 EAKEN AVE SE <br /> DELANO, MN 55328- TOTAL 242.12 <br /> (952)220-3786 <br /> Minnesota State License#: 20573411 <br /> OWNER <br /> ENGEBRETON, ANDREW& SALLY <br /> 175 CRYSTAL CREEK RD <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specifica[ions,applicable City approvals,and the <br /> State Building Code. This permit is for only the work described and does <br /> not gran[permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time after wark has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> reques[ed i co ormance with the State Building Code.This permit may be <br /> revoked at ti e for due caus n,,? <br /> � q �u� <br /> � 1 / Q�f `� Ce� i � _� ' �',�� <br /> Applican Pe rtee Signa re Date Issued Ey Si ature Date <br /> SEPARATE PERM[TS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />